Made available in DSpace on 2017-07-21T14:35:56Z (GMT). No. of bitstreams: 1 Jeanny Fraciela Kos Moleta.pdf: 1393942 bytes, checksum: 656dcc33e2bc51860b063d61430d320f (MD5) Previous issue date: 2017-03-10 / The World Health Organization (WHO) emphasizes that quality of life (QoL) is subjective, multidimensional, and includes both positive and negative aspects. Considering the multidimensional aspects of QoL, we can highlight the influence of oral health in this context, in which research has shown that the oral condition can affect QoL in patients with chronic diseases. The present study aimed to evaluate the impact of oral health on quality of life in patients diagnosed with chronic obstructive pulmonary disease (COPD). Regarding the methodology, the selection of patients was made at the Hospital Universitário Regional de Campos Gerais - HURCG (Ponta Grossa - PR). The study is characterized as a "Cross-Sectional Clinical Study" with two groups (1- Patients with COPD and 2- Control, patients without COPD), with 100 volunteers were defined in each group. The following questionnaires were applied in both groups: OHIP-14 and SF-36. In the form developed for the research were obtained: smoking, demographic data of schooling and dental habits. The socioeconomic condition was evaluated following the Brazilian Economic Classification Criteria of the Brazilian Association of Research Companies. According to the data distribution, the appropriate statistical tests were applied. The significance level was 5%. Regarding the results, we had the participation of 50 women and 50 men in each group, mean age was approximately 62 years (with about 60% of the population over 60 years) and the mean number of teeth was 5,85 teeth. The internal reliability of the questionnaires was evaluated using the alpha Cronbach (α), all α had results higher than 0.74. The COPD group had a greater impact of oral health on QoL in the total sum of OHIP-14 and in the domains: functional limitation, physical pain, psychological discomfort, psychological incapacity and disability. In all SF-36 domains, the COPD group had lower values, indicating a worse overall QoL. In conclusion, patients with COPD have a higher impact on oral health quality of life (HRQoL) compared to a population without COPD, and also have a lower overall QoL. / A organização mundial da saúde (OMS) destaca que a qualidade de vida (QV) é subjetiva, multidimensional e incluiu aspectos positivos e negativos. Considerando os aspectos multidimensionais da QV podemos destacar a influência da saúde bucal neste contexto, em que pesquisas vêm demonstrando que a condição bucal pode afetar a QV em pacientes portadores de doenças crônicas. O presente estudo objetivou avaliar o impacto da saúde bucal sobre a qualidade de vida em pacientes diagnosticados com doença pulmonar obstrutiva crônica (DPOC). Com relação à metodologia, a seleção de pacientes foi feita no Hospital Universitário Regional dos Campos Gerais - HURCG (Ponta Grossa – PR). O estudo é caracterizado como um “Estudo Clínico Transversal” com dois grupos (1- Pacientes portadores de DPOC e 2- Controle, pacientes não portadores de DPOC), com 100 voluntários em cada grupo. Foram aplicados os seguintes questionários nos dois grupos: OHIP-14 e SF-36. Em formulário próprio elaborado para a pesquisa foram obtidos: hábito de fumar, dados demográficos de escolaridade e hábitos odontológicos. A condição socioeconômica foi avaliada seguindo Critérios de Classificação Econômica Brasil da Associação Brasileira de Empresas de Pesquisas. De acordo com a distribuição dos dados foram aplicados os testes estatísticos apropriados. O valor de significância adotado foi de 5%. Com relação aos resultados tivemos a participação de 50 mulheres e 50 homens em cada grupo, a média de idade foi de aproximadamente 62 anos (com cerca de 60% da população com idade superior a 60 anos) e a média do número de dentes foi de 5,85 dentes. A confiabilidade interna dos questionários foi avaliada através do alfa Cronbach (α), todos os α tiveram resultados superiores a 0,74. O Grupo DPOC obteve maior impacto da saúde bucal na QV na soma total do OHIP-14 e nos domínios: limitação funcional, dor física, desconforto psicológico, incapacidade psicológica e invalidez. Em todos os domínios do SF-36 o grupo DPOC obteve valores mais baixos, indicando pior QV geral. Em conclusão pacientes com DPOC tem um maior impacto da qualidade de vida relacionada à saúde bucal (QVRSB) comparado à uma população sem a DPOC, e também apresentam uma QV geral mais baixa.

Made available in DSpace on 2015-03-05T19:35:31Z (GMT). No. of bitstreams: 0 Previous issue date: 22 / Nenhuma / A Doença Pulmonar Obstrutiva Crônica (DPOC) é uma patologia frequentemente acompanhada de um aumento dos sintomas de ansiedade e depressão. O objetivo desta dissertação foi investigar o efeito de uma intervenção psicológica cognitivo-comportamental associada à Psicoeducação nos sintomas de ansiedade, depressão e qualidade de vida em pacientes com DPOC. Participaram da pesquisa 22 pacientes divididos aleatoriamente em três grupos. Os pacientes do primeiro grupo (n=7) receberam o atendimento padrão do hospital. O segundo (n=8), o atendimento padrão e sessões de Terapia Cognitivo-Comportamental (TCC) e, para o terceiro (n=7), todo o procedimento anterior acrescido de uma sessão de Psicoeducação. Os participantes foram avaliados antes e após o atendimento com o Inventário Beck de Ansiedade e Depressão e o Saint George’s Respiratory Questionnaire (SGRQ), para a Qualidade de vida. Os dados foram analisados com técnicas estatísticas não-paramétricas para medidas repetidas. Os resultados indicaram que os participante / The Chronic Obstructive Pulmonary Disease (COPD) is a pathology often accompanied by an increase of anxiety and depression symptoms. The goal of this dissertation was the inquiry on the effects of a cognitive-behavioral psychological intervention associated to a psychoeducation of anxiety and depression symptoms, as well as quality of life, in patients with COPD. 22 patients randomly divided into three groups participated in the research. The patients of the first group (n=7) received the hospital’s medical standard of care. The second group (n=8) received the medical standard of care and cognitive-behavioral therapy sections (CBT) and the third group (n=7) received the procedures mentioned before with one psychoeducation section added. The participants were evaluated before and after the treatment, with the Beck Anxiety and Depression Inventory and the Saint George’s Respiratory Questionnaire (SGRQ), to quality of life. The data were analyzed with techniques from non-parametric statistics to repeated measur

Introdução. Os pacientes com DPOC apresentam capacidade de exercício reduzida e limitação funcional para realização de suas atividades diárias, impactando a qualidade de vida desses indivíduos. Além disso, foi demonstrado para esses indivíduos um maior risco de queda em comparação a indivíduos saudáveis da mesma idade. Contudo, não se sabe o papel da intolerância ao exercício em variáveis relacionadas a locomoção dos pacientes com DPOC como o custo de transporte (C), a velocidade autosselecionada (VAS) e a estabilidade dinâmica, que podem auxiliar na dimensão da influência dessa intolerância na vida diária desses indivíduos. Objetivo. O presente estudo se propôs a investigar o comportamento do C, da eficiência ventilatória, do conforto ventilatório e da estabilidade dinâmica em diferentes velocidades de caminhada de indivíduos com DPOC e comparar com indivíduos sem a doença, além de verificar a possível correspondência entre a VAS e a velocidade ótima. Materiais e Métodos. Onze participantes com DPOC fizeram parte desse estudo e foram comparados com onze controles pareados por sexo e idade. Eles foram primeiramente submetidos a um teste de exercício cardiopulmonar e, em um segundo momento, a uma avaliação do C. No protocolo submáximo, os participantes caminharam em cinco velocidades diferentes, sendo uma a VAS e outras quatro ±20% e ±40% da VAS. Além disso, os participantes foram avaliados em uma velocidade pré-determinada igual a todos (isovelocidade). Para todas as velocidades do protocolo os participantes caminharam durante cinco minutos. A partir dos valores de consumo de oxigênio (VO2) obtidos, foram calculados os valores de C. Simultaneamente, foram realizados registro de vídeos dos participantes para posterior análise cinemática da marcha. Foram calculados a frequência de passada (FP), o comprimento de passada (CP) e o coeficiente de variação (CoV) referente a FP, como medida da estabilidade dinâmica. Resultados. Não houve diferença do C dos pacientes com DPOC em relação aos controles, nem mesmo quando caminhavam em isovelocidade (p=0,623). Em todas as velocidades, os pacientes demonstraram menor eficiência ventilatória. A VAS dos pacientes foi menor, no entanto observou-se menor valor de C nas velocidades mais altas de caminhada. Apesar de os indivíduos com DPOC apresentarem menor FP e CP, a estabilidade dinâmica não demonstrou-se prejudicada na amostra estudada. Conclusão. Pacientes com DPOC caminham em velocidades reduzidas, em relação aos controles, especialmente devido à dispneia acompanhada de uma menor eficiência ventilatória. Embora o C seja semelhante ao de indivíduos saudáveis, os participantes com DPOC apresentaram o índice de reabilitação inferior, sugerindo, portanto, que o mecanismo pendular não esteja otimizado na VAS. Além de não encontrar diferenças na economia de caminhada, foram observadas alterações mínimas na estabilidade dinâmica da marcha destes indivíduos. Terapias que tratem do conforto ventilatório são potenciais ferramentas para a melhora da locomoção de pacientes com DPOC. / Background. Subjects with COPD present reduced exercise capacity and functional limitation to perform daily activities, which affects their quality of life. Furthermore, it is known that this population has increased risk of falls when compared to health subjects. However, it is still unknown the role of exercise intolerance on important variables to assess locomotion, as the cost of transport (C), the self-selected speed (VAS) and the dynamic stability, which might be able to help to dimension the exercise intolerance on their daily life. Objective. To investigate the behaviour of C ventilatory efficiency, ventilatory comfort and dynamic stability at different walking speeds in COPD subjects and compare them to healthy controls, as well as to verify the possible correspondence of VAS and optimal speed. Methods and Materials. 11 patients with COPD participated in this study and were matched with 11 control subjects in terms of gender and age. They underwent a cardiopulmonary exercise test and an evaluation of C. In this last evaluation, participants walked at five different walking speeds, among them VAS and the others ±20% and ±40% of the VAS. There was also a sixth predetermined walking speed (isovelocity). The participants walked during five minutes in each speed. The C values were calculated from the oxygen consumption (VO2) values. Simultaneously, the subjects were filmed for later analysis of gait kinematics. The stride frequency (FP), stride length (CP) and the coefficient of variation (CoV) from FP as a measure of dynamic stability, were calculated. Results. There was no significant difference between the C of participants with COPD and control subjects, not even when walking at isovelocity (p=0,623). For all speeds investigated, the ventilatory efficiency of COPD subjects was impaired when compared to healthy individuals. The participants in COPD group walked at a slower VAS, but the lower value of C was found during faster walking speeds. Even though the COPD group had less FP and shorter strides, their dynamic stability showed minimal impairment. Conclusion. The patients with COPD walked at a reduced walking speed when compared to control subjects, specially caused by dyspnea and a lower ventilatory efficiency. In spite of a similar C between groups, the COPD subjects presented an inferior rehabilitation index, therefore suggesting that their pendulum-like mechanism is not optimal at VAS. Furthermore, besides a walking economy with no differences between groups, minimal impairments were found for dynamic stability in COPD group. Therapies that treat ventilatory comfort are a potential tool to improve locomotion of COPD subjects.

Introdução: Transtornos psiquiátricos são comuns em pacientes com doenças pulmonares obstrutivas. Portadores de asma de difícil controle manifestam estes transtornos com freqüência superior àqueles com asma controlada. Entre os pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC) os sintomas de depressão podem estar relacionados à incapacidade progressiva e as limitações das atividades de vida diária. O objetivo do estudo foi verificar a presença de sintomas de ansiedade e depressão entre os portadores de asma e DPOC. Método: Foram avaliados os instrumentos específicos de quantificação de sintomas de ansiedade e depressão, IDATE e BDI respectivamente, respondidos por pacientes do ambulatório de asma e DPOC. A população constitui-se de 189 pacientes selecionados de três grupos de estudo com objetivos terapêuticos diferentes, sendo 140 asmáticos e 49 portadores de DPOC. Entre as variáveis destes estudos constavam sintomas de ansiedade e depressão como parte da metodologia. Os dados obtidos foram comparados levando-se em consideração aspectos demográficos, funcionais e de gravidade. Resultados: Entre os pacientes asmáticos foi significativamente maior a prevalência de ansiedade moderada e grave quando comparados com aqueles com DPOC (p<0,05). Em relação a depressão, o grupo de asma não controlada apresentou resultados significativamente maiores quando comparado ao grupo de asma controlada (p<0,05). Conclusão: Entre os pacientes asmáticos a freqüência de sintomas de ansiedade e depressão foi maior que entre aqueles com DPOC, o que pode dificultar o controle clínico / Introduction: Psychiatric disorders appear to be common in obstructive pulmonary disease patients. Difficult to control asthmatics show higher frequency of these disorders than controlled asthmatics. In Chronic Obstructive Pulmonary Disease (COPD) patients the depression symptoms may be related to progressive disability and limitations in daily living activities. Our objective was to verify the presence of anxiety and depression symptoms between asthmatic and COPD patients. Methods: Evaluation of anxiety and depression symptoms questionnaires, STAI and BDI respectively, from asthmatics and COPD outpatients clinics. It was a comparative study with 189 patients, 140 asthmatics and 49 with COPD. These patients were enrolled in three different treatment protocols: controlled asthmatics, not controlled asthmatics and stable COPD; all studies measured anxiety and depression symptoms in methodology. Data among groups were analyzed and correlated through demographic, functional and gravity aspects. Results: Moderate and severe anxiety symptoms in asthmatics were significantly higher when compared with COPD group (p<0,05). Not controlled asthmatics showed depression values significantly higher when compared with asthma controlled group (p<0,05). Conclusion: This study showed that anxiety and depression symptoms frequency is higher between asthmatics when compared to COPD patients, which may prevent a good clinical control

O formoterol é um fármaco beta-agonista de ação prolongada com rápido início de ação e eficácia broncodilatadora que podem determinar melhora significativa e imediata da função pulmonar. Pacientes com DPOC apresentam pouca ou nenhuma resposta ao broncodilatador (BD) no volume expiratório forçado no primeiro segundo (VEF1), podendo apresentar reversibilidade em outras variáveis se avaliados por pletismografia. O objetivo do estudo é avaliar por pletismografia a eficácia broncodilatadora do formoterol após 30 minutos de sua aplicação em portadores de DPOC. Foram estudados 40 pacientes portadores de DPOC com pobre resposta ao BD de curta ação. Encontravam-se no estágio II ou III da DPOC (SBPT/GOLD) e apresentavam VEF1 menor que 70% do valor previsto. Foram randomizados em dois grupos de 20 pacientes, com características clínicas semelhantes, recebendo cada um formoterol ou placebo, através de inalador de pó seco (aerolizer) com repetição das provas funcionais após 30 minutos. Foram observados aumentos significativos do VEF1 (12,4%) grupo formoterol (F) em relação ao grupo placebo (P) que foi de 0,1% (p=0,00065), da capacidade inspiratória (7,4% X 2,7%;p=0,05) e capacidade vital forçada (12,8% X 5,1%; p=0,017), redução importante da resistência das vias aéreas (-14% X 2,6% ; p=0,010). Foram ainda detectadas no grupo F modificações não expressivas do volume residual, da condutância das vias aéreas e da capacidade vital. Concluindo, em portadores de DPOC com pobre reversibilidade ao BD no teste espirométrico simples, o formoterol levou a uma melhora significativa da função pulmonar por pletismografia após 30 minutos de sua administração. / Formoterol is a long-acting ß2 agonist drug with rapid onset of action and the bronchodilator efficacy determine a prompt improvement in lung function. Patients with COPD may show minimal improvement after bronchodilator (BD) on volume in first second (FEV1), but they can show reversibility in other parameters if plethysmography was realized. The objective of this study was to evaluate, by plethysmography, the effectiveness of formoterol as a bronchodilator after 30 minutes of administration to patients with COPD. Forty COPD patients with poorly reversible obstruction confirmed by shortacting bronchodilator use at the spirometric test were prospectively evaluated. All patients were classified as having stage II or III SBPT/GOLD, presenting FEV1 lower than 70% of predict. The patients were randomized in two groups of 20, both with similar clinical characteristics, each group receiving either formoterol or placebo by dry powder device (aerolizer) and the lung function tests were repeated in 30 minutes after the drug administration. Significant increases in FEV1 (12,4%) in formoterol group (F) and 0,1% in placebo group (P) (P=0,00065), in inspiratory capacity (7,4% X 2,7% ; p=0,05) and in forced vital capacity (12,8% X 5,1%; p=0,017) and decrease in airway resistence (p=0,010) were observed in the F= -14% when compared with P= 2,6%. Residual volume decreased while specific airways condutance and vital capacity increased less important. In conclusion COPD patients with poor reversibility, formoterol promoted significant improvement in lung function by plethysmography after 30 minutes of its administration.

A doença pulmonar obstrutiva crônica é uma doença que leva à obstrução pulmonar geralmente irreversível e está intimamente relacionada com o hábito de fumar. Ao longo dos anos, ocorre destruição dos septos alveolares com a degradação das fibras elásticas e depósito do colágeno que compõe estes septos. Muito tem se discutido sobre a existência de inflamação sistêmica no paciente com DPOC e sobre as suas possíveis manifestações extra-pulmonares . O processo de aterosclerose pode fazer parte deste espectro inflamatório a partir da presença de dano endotelial. O fator de Von Willebrand é um marcador de dano endotelial e pode ser dosado de forma quantitativa e qualitativa. Este trabalho demonstra uma diferença estatisticamente significativa, qualitativa e quantitativamente, entre os níveis de fator de Von Willebrand em tabagistas e em pacientes com DPOC, quando comparados ao grupo controle. Ao analisarmos os pacientes com DPOC dividindo-os em subgrupos considerando quatro classificações distintas: GOLD 2006 (Anexo A), GOLD 2011 (Anexo B), grau de sintomatologia a partir da escala de dispneia MRC modificada (Anexo C) e número de exacerbações no último ano. Observamos uma diferença estatisticamente significativa, em relação ao nível qualitativo do fator de von Willebrand, apenas quando comparamos pacientes com DPOC sintomáticos e não sintomáticos. Demonstramos ainda uma correlação inversa entre o percentual predito de volume expiratório forçado no primeiro segundo (VEF1%) com os níveis qualitativos de fator de von Willebrand. Desta forma, o fator de von Willebrand está aumentado no paciente com DPOC, sendo um possível marcador sérico de sintomatologia relacionado a esta doença. Apesar de não se conseguir definir gravidade dos pacientes com DPOC pelo GOLD, o fator de von Willebrand estabelece uma correlação inversa com os níveis de VEF1%, sugerindo algum tipo de participação na progressão da doença. / Chronic obstructive pulmonary disease (COPD) is an entity that leads to pulmonary obstruction generally irreversible. This is closely related to the smoking habit and leads to alveolar septal destruction with elastic fibres degradation and collagen fibres degradation. There are many argues about the presence of systemic inflammation in the COPD patients. The atherosclerosis process can be part of this inflammation spectrum from the presence of endothelial damage. The von Willebrand factor is a marker of endothelial damage and may be measured in a quantitative and qualitative form. This study demonstrates a significant statistically difference in both qualitative and quantitative form of von Willebrand factor in smokers and COPD patients compared to the control group. When analyzing subgroups in COPD patients considering four different classifications: GOLD 2006, GOLD 2011, degree of symptoms from the MRC dyspnea scale and number of exacerbations in the last year. We observed a significant statistically difference in the level of qualitative von Willebrand factor only in the subgroup of the degree of symptoms. Inverse correlation was observed with the percent of forced expiratory volume in one second (FEV1%) and the qualitative von Willebrand factor. Thus, the von Willebrand factor is increased in COPD patient and could be a possible serum marker of the presence of symptoms in this patient. We cannot identify the severity of COPD patients in GOLD classification using von Willebrand factor, but we established a inverse correlation between qualitative von Willebrand factor and FEV1%, what may suggest a participation in the progression of the disease.

Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2014-09-02T14:56:13Z No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertacao Sheila Alves Pereira.pdf: 1561481 bytes, checksum: f5f41f977316e7afcdb4b84f89a0a92f (MD5) / Made available in DSpace on 2014-09-02T14:56:13Z (GMT). No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertacao Sheila Alves Pereira.pdf: 1561481 bytes, checksum: f5f41f977316e7afcdb4b84f89a0a92f (MD5) Previous issue date: 2013-05-06 / Introduction: The detection of patients with Chronic Obstructive Pulmonary Disease (COPD) on the primary health care network can be an important tool for an early diagnosis and better conduct management of these patients. Studies realized in Latin America (MENEZES, 2006) show that the COPD underdiagnosis is one of the great limiters for the control of this illness. It was also observed in a study in Canada (Hill et al., 2010) that half of the cases sub-diagnosed were of hypertensive patients. Thus, the analysis of the pulmonary function in hypertensive patients could be a useful strategy for the diagnosis of patients with COPD. Objective: To estimate the prevalence of COPD and its sub-diagnosis on hypertensive patients registered on the HIPERDIA Program of an unit of primary health care in Goiânia. Methodology: The transversal analytical study performed on the Novo Horizonte CIAMS in Goiânia from January/2011 to May/2012, with patients from both sex, aged between 18 and 80 years old and hypertensive registered on the HIPERDIA Program. The patients were evaluated as for the pulmonary function (spirometry) and the respiratory symptoms (questionnaire). The criteria used for the diagnosis f COPD were in fixed relation of the VEF1/CVT<0,70 or by the relation VEF1/CVF below the inferior limit of normality. For the statistical analysis, it was appealed to the SPSS 17.0 program, with the execution of the square Qui test, T test and analysis of the logistical regression. The level of statistic significance assumed was of p < 0,05. The present study was approved by the Ethical Committee of Human Research from the Clinical Hospital of the Federal University of Goiás, register n° 159/2010. Results: 301 patients were evaluated. The prevalence of COPD was of 22,2% and the sub-diagnosis rate was of 82%. The group with normal spirometry (n=165) was compared to the group with COPD (n=67) as for the social demographic variables, pulmonary function, risk factors, the respiratory symptoms and the co morbidity. There were significant differences only in relation to the sex (p<0,001), age (p=0,005), CVF, VEF1/CVF (p<0,001), smoking (p<0,001) and wheezing (p=0,006). The group of patients with sub-diagnosed with COPD (n=55) and with previous diagnosis (n=12) were similar as for all the variables of epidemiological characterization, except for the respiratory symptoms (wheezing and dyspnea) and pulmonary function. Conclusion: The COPD patients’ profile is similar to the literature. The high prevalence of COPD found in the patients on the HIPERDIA Program with the majority of the sub-diagnosed, shows that the implantation of management strategies with patients with COPD in this National Program of Public Health is already existent in the majority of the Brazilian cities. / Introdução: A detecção de pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC) na rede de atenção primária de saúde pode ser uma ferramenta importante para diagnóstico precoce e melhor manejo na conduta desses pacientes. Estudos realizados na América Latina (MENEZES, 2006) demonstraram que o subdiagnóstico de DPOC é um dos grandes limitadores para o controle dessa enfermidade. Também foi observado em um estudo no Canadá (HILL et al., 2010) que metade dos casos subdiagnosticados era de pacientes hipertensos. Sendo assim, a análise da função pulmonar em pacientes hipertensos poderá ser uma estratégia útil para o diagnóstico de pacientes com DPOC. Objetivo: Estimar a prevalência de DPOC e de seu subdiagnóstico em pacientes hipertensos cadastrados no Programa HIPERDIA de uma unidade de atenção primária à saúde em Goiânia. Metodologia: Estudo transversal analítico realizado no CIAMS do Novo Horizonte da cidade de Goiânia no período de janeiro/2011 a Maio/2012, com pacientes de ambos os sexos idade entre 18 e 80 anos, hipertensos inscritos no Programa HIPERDIA. Os pacientes foram avaliados quanto à função pulmonar (espirometria) e aos sintomas respiratórios (questionário). Os critérios usados para diagnóstico de DPOC foram pela relação fixa do VEF1/CVF<0,70 ou pela relação VEF1/CVF abaixo do limite inferior da normalidade. Para análise estatística, recorreu-se ao programa SPSS 17.0, com a realização de teste Qui quadrado, teste t student e análise de regressão logística. O nível de significância estatística adotado foi de p < 0,05. O presente estudo foi aprovado pelo Comitê de Ética em Pesquisa Humana do Hospital das Clínicas da Universidade Federal de Goiás, registro nº 159/2010. Resultados: Foram avaliados 301 pacientes. A prevalência de DPOC foi de 22,2% e a taxa de subdiagnóstico foi de 82%. Comparou-se o grupo com espirometria normal (n=165) com o grupo DPOC (n=67) quanto às variáveis sociodemográficas, a função pulmonar, os fatores de risco, os sintomas respiratórios e as comorbidades. Houve diferenças significantes apenas em relação a sexo (p<0,001), idade (p=0,005), CVF, VEF1 e VEF1/CVF (p<0,001), fumo (p<0,001) e sibilos (p=0,006). Os grupos de pacientes com DPOC subdiagnosticados (n=55) e com diagnóstico prévio (n=12) foram semelhantes quanto a todas as variáveis de caracterização epidemiológica, exceto quanto aos sintomas respiratórios (sibilo e dispneia) e função pulmonar. Conclusão: O perfil dos pacientes DPOC é semelhante ao da literatura. A alta prevalência de DPOC encontrada nos pacientes do Programa HIPERDIA com maioria de subdiagnosticados sinaliza para implantação de estratégias de manejo de pacientes com DPOC nesse Programa de Saúde Pública Nacional já existente na maioria dos municípios brasileiros.

A characteristic feature of Chronic Obstructive Pulmonary Disease (COPD) is an abnormal inflammatory response in the lungs to inhaled particles or gases. The ability to assess and monitor this response in the lungs of COPD patients is important for understanding the pathogenic mechanisms, but also provides a measure of the activity of the disease. Disease activity is more likely to relate to lung inflammation rather than the degree of airflow limitation as measured by the FEV1. Preliminary studies have shown the 18F fluorodeoxyglucose positron emission tomography (18F FDG-PET) signal, as a measure of lung inflammation, is quantifiable in the lungs and is increased in COPD patients compared to controls. However, the methodology requires standardisation and any further enhancement of the methodology would improve its application to assess inflammation in the lungs. I investigated various methods of assessing FDG uptake in the lungs and assessed the reproducibility of these methods, and particularly evaluated whether the data was reproducible or not in the COPD patients (smokers and ex-smokers). This data was then compared with a group of healthy controls to assess the role of dynamic 18F FDG-PET scanning as a surrogate marker of lung inflammation. My data showed a good reproducibility of all methods of assessing FDG lung uptake. However, using conventional Patlak analysis, the uptake was not statistically different between COPD and the control group. Encouraging results in favour of COPD patients were nonetheless shown using compartmental methods of assessing the FDG lung uptake, suggesting the need to correct for the effect of air and blood (tissue fraction effect) when assessing this in a highly vascular organ like the lungs. A prospective study analysis involving a bigger cohort of COPD patients would be desirable to investigate this further.

CT is a powerful method for noninvasive assessment of the lung. Advancements to CT technology have guided the high-resolution structural and functional assessment of lung diseases. This has helped make the transition from characterizing the severity of lung disease to novel phenotyping of disease subtypes. Chronic obstructive pulmonary disease (COPD) is a spectrum of inflammatory lung disease affecting lung parenchyma, airways, and the pulmonary and systemic vasculature. Quantitative CT-based measures have largely focused on quantifying the extent of airway and parenchymal damage with disease. Recently perfusion CT method has been used to assess the pulmonary vascular bed. This technique was used to demonstrate a vascular etiology of smoking-associated centriacinar emphysema (CAE), a subtype of the COPD spectrum. However, technical challenges have limited the transition of this CT method to clinical studies to assess pulmonary vascular physiology. In this thesis, we introduce dual energy CT-perfused blood volume (DECT-PBV) as a novel image-based biomarker to assess peripheral pulmonary vascular dysfunction. Using this technique, we show that smoking-associated pulmonary perfusion heterogeneity, a marker of abnormal blood flow is a reversible process, in the midst of smoking-associated lung inflammation, and not a product of advanced lung disease. We demonstrate, via regional PBV measures and structural measures of the central pulmonary vessels, that the reversibility of pulmonary perfusion heterogeneity is a direct result of increased peripheral (downstream) parenchymal perfusion. We validate our quantitative imaging approach in a unique cohort of early CAE-susceptible smokers using a pharmaceutical intervention to dilate the pulmonary parenchymal vascular bed. The validated DECT approach and our novel DECT imaging findings extend our characterization of the vascular phenotype in inflammatory lung disease and provide a framework for future quantitative imaging studies of the lung to assess early intervention targeted to pulmonary vessels.

Chronic pulmonary diseases include a wide range of illnesses that differ in etiology, prevalence, symptomatology and available therapy. A common link among these illnesses is their impact on patients’ vital function of breathing, high symptom burden and significantly impaired quality of life. This dissertation research evaluates disease severity, symptom burden and health behaviors of patients with three different chronic pulmonary conditions. First, alpha-1 antitrypsin deficiency (AATD) is an inherited condition that typically is associated with an increased risk of early onset pulmonary emphysema. This study examines differences in demographic, health, and behavioral characteristics and compares clinical outcomes and health related behaviors and attitudes between two severe genotypes of AATD - ZZ and SZ. The findings of the study suggest that patients with SZ genotype and less severe form of deficiency report higher number of exacerbations, comorbidities, as well as unhealthy behaviors such as lack of exercise and current smoking. In addition, individuals with the more severely deficient ZZ genotype are more adherent to disease management and prevention program recommendations and maintain a healthier lifestyle than individuals with SZ genotype. Second chronic lung disease examined in this research was chronic obstructive pulmonary disease (COPD), the fourth leading cause of death and second leading cause of disability in the United States. Prevalence and burden of cough and phlegm, two of the most common symptoms of the COPD, were assessed among participants of the COPD Foundation’s Patient-Powered Research Network (COPD PPRN). In addition, association between patient-reported levels of phlegm and cough, clinical outcomes and patients’ quality of life were evaluated. Participants’ quality of life was assessed using Patient Reported Outcome Measurement Information System instrument PROMIS-29. Association between changes in symptom severity over time and patient-reported quality of life were examined. Findings of this study indicated that severity of cough and phlegm were associated with higher number of exacerbations, greater dyspnea, and worsened patient-reported quality of life including physical and social functioning. Improvement in cough and phlegm severity over time was associated with better patient-reported quality of life. Third pulmonary illness described in this dissertation is non-cystic fibrosis bronchiectasis (NCFB), a rare and etiologically diverse condition characterized by dilated bronchi, poor mucus clearance and susceptibility to bacterial infection. Association between presence of Pseudomonas aeruginosa (PA), one of the most frequently isolated pathogens in patients with NCFFB, and disease severity was assessed utilizing enrollment data from the Bronchiectasis and NTM Research Registry (BRR). NCFB disease severity was evaluated using modified versions of validated in large international cohorts instruments, the Bronchiectasis Severity Index (BSI) and FACED. The findings of this study indicate that PA infection is common in NCFB patients, and presence of PA in patients’ sputum is associated with having moderate and high severity of bronchiectasis. In addition, the results of this study suggest that the two severity assessment instruments classify patients with NCFB differently which may be attributed to a greater number of severity markers utilized in the calculation of the BSI compared to FACED. In conclusion, the proposed dissertation aims to enhance understanding of differences in health outcomes between genotypes of AATD within AlphaNet registry, and to guide future health-promoting behaviors. It highlights the burden of common symptoms such as cough and phlegm in patients with COPD within COPD PPRN and their association with patients’ quality of life. In addition, it introduces modified indices of NCFB severity and emphasizes high burden of the disease in patients with presence of PA within the US BRR.